Discussion: Literature Evaluation Table

Discussion: Literature Evaluation Table ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Literature Evaluation Table ? Discussion: The basic story of Florence Nightingale is familiar to most nurses. This week we learned more about Nightingale’s life and work. Select at least one piece of the Nightingale legacy that was new to you and tell us how this changed your understanding of this great woman and her contributions to nursing. Discussion: Literature Evaluation Table Please feel free to use any or all of the enclosed references. The only required reference is from Judd & Sitzman. https://www.florence-nightingale.co.uk/resources/b… References Biography of Florence Nightingale. (2019). Retrieved from https://www.florence-nightingale.co.uk/resources/b… Judd, D. and Sitzman, K. (2014) A History of American Nursing: Trends and Eras. Jones and Bartlett Learning. Burlington, MA. McDonald, L. (2014). Florence Nightingale, statistics and the Crimean War. Journal of the Royal Statistical Society: Series A (Statistics in Society) , 177 (3), 569–586. https://doi-org.chamberlainuniversity.idm.oclc.org… Zborowsky, T. (2014). The Legacy of Florence Nightingale’s Environmental Theory: Nursing Research Focusing on the Impact of Healthcare Environments. Health Environments Research & Design Journal (HERD) (Vendome Group LLC) , 7 (4), 19–34. https://doi-org.chamberlainuniversity.idm.oclc.org… fn_environmental_theory.pdf crimeanwar.pdf chapter5_florence_nightingale.docx FLORENCE NIGHTINGALE AND IMPACT OF HEALTHCARE ENVIRONMENTS RESEARCH The Legacy of Florence Nightingale’s Environmental Theory: Nursing Research Focusing on the Impact of Healthcare Environments Terri Zborowsky, PhD, EDAC ABSTRACT OBJECTIVE: The purpose of this paper is to explore nursing research that is focused on the impact of healthcare environments and that has resonance with the aspects of Florence Nightingale’s environmental theory. BACKGROUND: Nurses have a unique ability to apply their observational skills to understand the role of the designed environment to enable healing in their patients. This affords nurses the opportunity to engage in research studies that have immediate impact on the act of nursing. METHODS: Descriptive statistics were performed on 67 healthcare design-related research articles from 25 nursing journals to discover the topical areas of interest of nursing research today. Data were also analyzed to reveal the research designs, research methods, and research settings. These data are part of an ongoing study. AUTHOR AFFILIATIONS: Terri Zborowsky is a Research Associate at The Center for Health Design; a Principal at Zborowsky Healthcare Design Consulting; and Research Chair at the Nursing Institute for Healthcare Design. CORRESPONDING AUTHOR: Terri Zborowsky, [email protected]; (651) 724-0081. © 2014 VENDOME GROUP LLC RESULTS: Descriptive statistics reveal that topics and settings most frequently cited are in keeping with the current healthcare foci of patient care quality and safety in acute and intensive care environments. Discussion: Literature Evaluation Table Research designs and methods most frequently cited are in keeping with the early progression of a knowledge area. CONCLUSIONS: A few assertions can be made as a result of this study. First, education is important to continue the knowledge development in this area. Second, multiple method research studies should continue to be considered as important to healthcare research. Finally, bedside nurses are in the best position possible to begin to help us all, through research, understand how the design environment impacts patients during the act of nursing. KEYWORDS: Evidence-based design, literature review, nursing ACKNOWLEDGMENTS: Part of the funding for the article review process was provided by The Center for Health Design. PREFERRED CITATION: Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. Health Environments Research & Design Journal, 7(4), 19–34. HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL?? 19 RESEARCH SUMMER 2014 • VOL. 7 NO. 4, pp. 19–34 F lorence Nightingale was one of the first nurses to document the impact of the built environment on patients. In addition to writing about sanitation, infection rates, and ventilation, Nightingale understood that environmental aspects such as color, noise, and light, along with the nurse’s presence, significantly contributed to health outcomes. Dossey (2005) has summarized Nightingale’s comments on the defects of hospital construction that compromised health, including: • Arrangement of the bed along the dead wall and more than two rows of beds between the opposite windows. • Defective means of natural ventilation and warming; windows only on one side, or a closed corridor connecting the wards. • Defective height of wards and excessive width of wards between the opposite windows. • Defective ward furniture. Discussion: Literature Evaluation Table • Defective hospital kitchens and laundries. • Defective condition of water closets. • Defects of sewerage. • Use of absorbent materials for walls and ceilings, and poor washing of hospital floors. • Selection of bad sites and bad local climates for hospitals and erecting of hospitals in towns. • Defective accommodation for nursing and discipline. It is clear that Nightingale was well aware of the impact the built environment had on patients—she knew this from direct observation. In fact, all of her assertions were from her acute observations of patient or community outcomes and their surroundings. Nightingale’s environmental theory can be viewed as a systems model that focuses on the “client” in the center, surrounded by aspects of the environment all in balance. If one element is out of balance, then the client is stressed, and it is up to the nurse to do what is needed to bring back balance to the client’s surrounding environment to relieve the stress (Lobo, 2011). Nurses have been the primary caregivers of the sick, infirmed, and the injured. While doctors and allied practitioners assist in patient diagnosis and treatment, nurses have always been at the bedside of the patient, delivering the care prescribed, whether the care is provided in an infirmary, hospital, or in the patient’s home. Since Nightingales’ documentation of her “bedside’ experiences, the role of the nurse has evolved and changed. Nursing has evolved from a vocation to a professional career. Nurses today can be educated in a variety of specialties. Nurse practitioners diagnose and treat their own patients. Nurses play an important role in healthcare leadership as Chief Nursing Officers or Chief Executive Officers, often putting in place the policies needed to provide quality patient care. Other nurses specialize in research, both in academia as well as in clinical settings. Yet today nurses remain the most likely of healthcare professionals to be 20??Discussion: Literature Evaluation Table ?WWW.HERDJOURNAL.COM © 2014 VENDOME GROUP LLC FLORENCE NIGHTINGALE AND IMPACT OF HEALTHCARE ENVIRONMENTS RESEARCH at the patient’s side delivering the care needed. It is in the very act of nursing that an intimate relationship is created, one that puts the nurse in a unique position. Similar to Nightingale, nurses today see the influence of the surrounding environment on the patient’s ability to heal. This makes nurses uniquely able to apply their observation skills to understanding the role of the designed environment to enable healing in their patients. These types of observations afford nurses the opportunity to contribute greatly to this growing body of knowledge. The purpose of this article is to explore the role that nurses have played in the development of research studies that resonate with aspects of Nightingale’s environmental theory. The particular aspects of interest are those from the built or ambient environment, termed the “designed environment” for this article. Nightingale (1860) listed these aspects as: • Noise • Light • Air • Ventilation • Cleanliness • Variety This article uses data from an ongoing study to explore these and other variables of interest in current nursing research journals. To provide context for this research, a brief review of nurses in healthcare design and related literature is included. This article also includes recommendations to advance a research agenda for bedside nurses. Overview Few government healthcare reports have garnered public attention like the Institute of Medicine’s To Err Is Human: Building a Safer Healthcare System (2000). The report was a comprehensive look at medical errors and the quality of healthcare in the U.S. and as a result disclosed the failure of this healthcare system to protect the very people it should, its patients. The disclosures in the report shocked many in the public realm, but to those who worked in the system, many of them nurses, it served as an acknowledgement of issues of which they were already aware. However, nurses understood assigning blame on human error alone was not going to solve the larger systemic issues healthcare organizations faced (Tri-Council of Nurses, 2000). Discussion: Literature Evaluation Table As with most dark clouds, however, there was a silver lining. The report sparked a series of follow-up reports that explored the problems underlying the dismal statistics and provided solutions. For nurses this meant discussions would focus on understanding how their work environment, as part of the larger system, affected the quality of patient care. In both the original To Err Is Human report and the subsequent report, Crossing the Quality Chasm: A New Health System for the 21st Century (Institute of Medicine, 2001), the overall concept of nurses’ work environment was discussed © 2014 VENDOME GROUP LLC HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL?? 21 RESEARCH SUMMER 2014 • VOL. 7 NO. 4, pp. 19–34 as it related directly to patient safety and quality care. However, not until the 2004 report, Keeping Patients Safe: Transforming the Work Environment of Nurses (Institute of Medicine, 2004) were the various parts unravelled and the physical aspects of nurses work environment discussed in depth. Chapter 6, “Work and Workspace Design to Prevent and Mitigate Errors” dealt specifically with the “evidence on the design of nurses’ work hours, work processes, and workspaces, primarily as they relate to patient safety, but also with respect to efficiency” (IOM, 2004, p. 227). After a thorough review of nursing work issues such as medication errors, fatigue, hand washing, distractions, supply management, acuity adaptable patient rooms among other issues, several recommendations were made, including: • Nursing leadership should be provided with resources that enable them to design the nursing work environment and care processes to reduce errors, and should concentrate on errors associated with: — Surveillance of patient health status. — Patient transfers and other patient hand-offs. — Complex patient care processes. — Non-value added activities performed by nurses, such as locating and obtaining supplies, looking for personnel, completing redundant and unnecessary documentation, and compensating for poor communication systems. • Hand washing and medication administration should be addressed (IOM, 2004, p. 13). Chapter 6 and the recommendations revealed an important fact: Physical aspects of nurses’ work environment significantly impact their ability to perform their job and, as a result, impact patient care outcomes. Keeping Patients Safe revealed how using quality improvement tools such as Lean or Six Sigma could help redesign these work environments to decrease the chances of error and increase value added time for the nurse. Discussion: Literature Evaluation Table Nurses’ time is better spent at the bedside, providing the care and education needed to improve patient outcomes. Sadly, 10 years later, many of the same problems remain. Nurses face an increasingly complex patient population with diminishing resources available to them. When building projects are underway and the opportunity exists to engage nurses in the design and planning of these work environments, rarely is this opportunity to make the changes so badly needed utilized. As Gregory (2009) noted in her editorial, “Nobody Asked Me: Why Nurses Should Take an Interest in Workplace Design,” nurses have not been asked to be at the table during the design process. As a result of the disconnect she witnessed, Gregory helped launch the Nursing Institute for Healthcare Design (NIHD) with the vision to help educate and empower nurses to bring their “bedside” knowledge to the table when the opportunity to design their workspaces occurs. “We challenge nurses to learn about what other nurses are doing to influence hospital design, to research design trends, and to speak up, using their experience and problem-solving skills to improve their work surroundings” (Gregory, 2009, p. 11). 22???WWW.HERDJOURNAL.COM © 2014 VENDOME GROUP LLC FLORENCE NIGHTINGALE AND IMPACT OF HEALTHCARE ENVIRONMENTS RESEARCH Within healthcare systems, nurses remain strong advocates for their patients and family members; they remain at their bedside providing the care that is needed, and they remain ever vigilant, observing and documenting what they see, hear, and feel. In 2010, the Robert Wood Johnson Foundation (RWJF) published “Addressing the Quality and Safety Gap—Part III: The Impact of the Built Environment on Patient Outcomes and the Role of Nurses in Designing Health Care Facilities” (Robert Wood Johnson Foundation, 2010). It noted, “[N]urses at all levels and in every setting have a critical role to play on multidisciplinary teams charged with assessing, planning, and designing new and replacement facilities” (p. 1). The report goes on to discuss the role of research findings, specifically evidence-based design (EBD), to provide the framework from which to make design decisions during the design process. This is particularly true when considering the importance of integrating architecture, information technology, clinical processes, and workplace culture. What this document did so well was to highlight how nurses can explore the aspects of the designed environment that affect the quality of patient care and safety. As noted by Kerm Henriksen, PhD, the human factors advisor for patient safety at the Agency for Healthcare Research and Quality, “Nursing is the backbone for what goes on in hospitals. Discussion: Literature Evaluation Table Nurses have a lot of practical knowledge and can help identify design threats to patient safety and quality of care” (RWJF, 2010, p. 2). Figure 1. Aligning Infrastructure, Leadership, and Processes: A Multidisciplinary Model. Transformational Leadership and Culture h s ea Re ar c Research se r ch Re Infrastructure: Building, Technology, Furniture, Equipment Strategic Goals: Improved Patient, Staff, and Resource Outcomes Reengineered Clinical and Administrative Processes Source: Adapted from Evidence-Based Design: Application in the Military Health System, E. Malone, J. R. Mann-Dooks, & J. Strauss (Noblis, 2007, p. 12). Used with permission. © 2014 VENDOME GROUP LLC HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL?? 23 RESEARCH SUMMER 2014 • VOL. 7 NO. 4, pp. 19–34 Malone, Mann-Dooks, and Strauss (2010) presented a framework for understanding how healthcare leaders can solve clinical problems utilizing research in the process. Malone, herself a nurse and former CEO and commander emeritus of DeWitt Army Community Hospital at Fort Belvoir, noted that coordination in this area is often missing. “[W]e have these wonderful stovepipes of innovation but very little integration because architects, IT experts, and clinicians tend to work in separate silos.” (Malone, Mann-Dooks, & Strauss, 2010, p. 3). Their model provides a conceptual framework to examine the interplay among physical, technological, and human factors, as well as the need for more multidisciplinary research. Finally, Lamb and Zimring (2010) offered some pedagogical solutions. Together, with a group of educators from around the country, they identified interprofessional competencies for systems integrators—leaders capable of bringing together experts from different disciplines, including nursing. “The real challenge is to integrate knowledge from different professional disciplines to create better and safer health care environments.” (Lamb & Zimring, 2010, p. 8). Six domains were identified for teaching: 1. Science of healthcare design—applying and extending evidence-based research; 2. Healthcare systems and environments—describing and influencing the context in which services are planned, delivered, and evaluated; 3. Patient- and family-centered care—engaging patients in their own care and mobilizing and leveraging support systems; 4. Teamwork—facilitating collaboration and communication among different stakeholders; 5. Professional cultures—identifying and capitalizing on expertise of designers, architects, engineers, clinicians, and so on; and 6. Innovation—thinking creatively to solve problems. In March 2014, RWJF published “Ten Years After Keeping Patients Safe: Have Nurses’ Work Environments Been Transformed?” This paper revisited some of the recommendations in the Institute of Medicine’s report for averting harm, highlighting both progress and persistent gaps in transforming nurses’ work environments, and showcased research, policies, and tools with the potential to advance this transformation. This RWJF document fell short, however, in addressing the role of the built environment in helping to overcome the quality gap. The discussion about improving nurse work environments should be focused on people, process, and place as interrelated concepts. Discussion: Literature Evaluation Table Kreitzer and Zborowsky (2009) used these concepts to explore the creation of “Optimal Healing Environments.” Examining the relationship between people and process is not enough; the designed environment must be included in the discussion. Previous literature reviews in this field of knowledge have stressed the impact that the designed environment has on staff efficacy, satisfaction, and safety, as well as patient outcomes, including physiological, behavioral, and psychological (Rubin, Owens, & Golden, 1998; Ulrich, Zimring, Quan, Joseph, & Choudhary, 2004; Ulrich 24???WWW.HERDJOURNAL.COM © 2014 VENDOME GROUP LLC FLORENCE NIGHTINGALE AND IMPACT OF HEALTHCARE ENVIRONMENTS RESEARCH et al., 2008). It is time to look more closely at the legacy of Nightingale and the role nurses have played in conducting nursing research, studies that reveal the impact of the designed environment on their patients and on the act of nursing. Nurse Research on the Impact of Healthcare Environments Outside of Florence Nightingale’s work, there is little documentation of the role nurse researchers might play in this knowledge domain, although it is clear that nurses have been publishing research on the impact of the design environment on nurses’ ability to conduct their work safely and efficiently, as well as on patient outcomes. In the past, nurses may not have had the design vocabulary to explain their studies within the healthcare design domain. These two knowledge areas, healthcare and health design, had not frequently crossed paths. It was not until the Institute of Medicine’s initial healthcare quality report (1999) that nursing researchers and others started to rigorously explore all aspects of healthcare— people, process, and place—for help in understanding how to fix the quality gap. Bedside nurses were on the frontlines of the discussion. Not just observers of this phenomena, they were actors as well. They were, in essence, studying their own experiences—how the designed environment impacted their patients and enabled them to provide the very best care. Nurses feel the effects of a lack of proper air temperature. They see the work-arounds created because of poor spatial adjacencies and they understand how it feels to make patient decisions while standing in a corridor that might have decibel level peaks similar to a freeway. Many nurses observed these effects, but it was only through conducting research that they were able to explore how to make needed change. Nursing journals have been around since the early 20th century. The American Journal of Nursing, first published in 1900, is still in print. These journals have served to document the research and opinions of nurses through the years. At some point, articles began to examine the role of the designed environment in care delivery. Many articles published in this genre through the years appear to be quality improvement strategies. So what can we learn from further examination of these studies? What might this research offer to us as practitioners of nursing and/or design? What might the research tell us about Nightingale’s environmental theory—is it relevant today? The rest of this article will explore answers to these questions. Using a literature review approach, it will identify how variables in Nightingale’s environmental theory are explained or explored in studies published in nursing journals. The literature review below examines selected nursing journals. It is part of a larger study to be published at a … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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